Six-year trajectories of cognitive, physical and social functioning in adults with late-life depression

Late-life depression (LLD) is often accompanied by functional limitations, which may persist after symptomatic improvement, increasing relapse risk. Care for functional limitations in LLD is difficult, as they vary across different domains and are linked to both depression and aging. This study identified six-year trajectories of cognitive, physical and social functional in persons with LLD.

355 depressed participants from the Netherlands Study of Depression in Older persons (NESDO; age 60-90; 66.1% women) were included with at least two repeated observations (maximum 13) over six years. Depression diagnosis, symptom severity and functional limitations across domains (i.e. Cognition, Mobility, Self-care, Getting along with people, Household activities and Participation in society) were assessed. Functional trajectories were estimated using Growth Mixture Modeling and depressive symptom courses using mixed models.

Two-class models fitted best for Cognition, Getting along with people, Household activities and Participation in society, and three-class models for Mobility and Self-care. Most participants had relatively stable trajectories of either high or low-to-moderate limitations across domains. Small subgroups showed strong deterioration in Mobility, Self-care and Household activities, while another subgroup showed strong recovery in Getting along with people. Functional trajectories often only weakly aligned with symptomatic courses and varied across domains within individuals, resulting in heterogeneous combinations of favourable and unfavourable trajectories.

Functional limitations vary across domains in LLD. They often persist independently of depressive symptoms, highlighting the need for individualized interventions to improve long-term outcomes in older adults. Limitations included modest sample size and lack of pre-morbid functioning data.